=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255431110
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA GRAZZIUTTI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 10/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4301 W MARKHAM ST UAMS #783
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-7101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-686-8000
-----------------------------------------------------
Fax | 501-686-5609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4301 W MARKHAM ST UAMS #783
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-7101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-686-8000
-----------------------------------------------------
Fax | 501-686-5609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | E-4841
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | E-4841
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------